Ryan White CARE Act: Program Changes Affecting Minority AIDS Initiative and Part D Grantees Page: 2 of 11
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Accountability. Integrity* Reliability
Highlights of GAO-09-1027T, a testimony
before the Subcommittee on Health,
Committee on Energy and Commerce,
House of Representatives
Why GAO Did This Study
Under the Ryan White
Comprehensive AIDS Resources
Emergency Act of 1990 (CARE Act)
federal funds are made available to
assist those affected by human
(HIV/AIDS). The Health Resources
and Services Administration
(HRSA) awards CARE Act grants to
states, territories, metropolitan
areas, and others. The Ryan White
HIV/AIDS Treatment Modernization
Act of 2006 (RWTMA) reauthorized
CARE Act programs for fiscal years
2007 through 2009. The CARE Act's
Minority AIDS Initiative (MAI)
provides for grants through five
parts (A, B, C, D, and F) with the
goal of reducing HIV-related health
disparities among minorities.
RWTMA changed how HRSA
awards MAI grants under Part A
and Part B from a formula based on
the demographics of the grantee to
a competitive process. Part D
provides for grants for services to
women, infants, children, and
youth with HIV/AIDS and their
families. RWTMA capped Part D
administrative expenses at 10
percent. GAO was asked to testify
about CARE Act changes resulting
from RWTMA. This testimony
discusses (1) the implementation of
the MAI provisions and
(2) grantees' experiences under the
Part D administrative expense cap.
This testimony is based on two
GAO reports, Ryan White Care
Act: Implementation of the New
Minority AIDS Initiative
Provisions, GAO-09-315, and Ryan
White Care Act: First-Year
Experiences under the Part D
Administrative Expense Cap,
View GAO-09-1027T or key components.
For more information, contact Marcia Crosse
at (202) 512-7114 or firstname.lastname@example.org.
RYAN WHITE CARE ACT
Program Changes Affecting Minority AIDS Initiative
and Part D Grantees
What GAO Found
The new competitive process for awarding MAI grants altered funding for
grantees, increased administrative requirements for grantees, and resulted in
continued funding for existing initiatives. The new competitive application
process for Part A grantees-metropolitan areas-and Part B grantees-states
and territories and associated jurisdictions-altered MAI grants from what
they would have been under the old formula-based process. In determining
the award amounts under the new process, HRSA considered the number of
minorities with HIV/AIDS living in the grantee jurisdiction, along with the MAI
applications grantees were required to file. The new competitive grant
applications sometimes resulted in considerable differences in grantees' share
of MAI funds from what they would have received under the old process. For
example, in fiscal year 2007, Phoenix received $127,578 (39.8 percent) less
than it would have received under the old formula, while Houston received
$154,018 (10.9 percent) more. In addition, Part A and B grantees that received
MAI funding told GAO that the administrative requirements increased
significantly because of the new process. These included a new MAI grant
application and reporting requirements. All Part A and B grantees that applied
for MAI funding received it, but some Part B grantees decided that the
administrative requirements, including a separate application for MAI funds,
were not worth the amount of funds that they expected to receive and
therefore chose not to apply. Moreover, grantees said that they generally
funded the same service providers and initiatives to reduce minority health
disparities as they had in prior years. MAI grantees continued to fund a range
of core medical services, which include essential medical care services, and
support services, which are services needed for individuals with HIV/AIDS to
achieve their medical outcomes.
In a survey of Part D grantees, GAO found that grantees provide a range of
services to clients, and the majority of these grantees reported that they have
not made changes to services in response to the administrative expense cap
implemented in fiscal year 2007. These services included both medical
services, such as outpatient health services, as well as support services, such
as child care. The majority of the 83 grantees that responded to GAO's survey
reported that the cap has not affected the services they provide. However,
four grantees reported increasing services and three grantees reported
reducing client services in response to the cap. In addition, the majority of
grantees also reported that the cap has had a negative effect on their Part D
programs, even if it has not changed client services, because it has, for
example, made it necessary for clinical staff to perform administrative tasks.
In addition, about half of the grantees reported that not all of their Part D
administrative expenses were covered by the 10 percent allowance.
.United States Government Accountability Office
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United States. Government Accountability Office. Ryan White CARE Act: Program Changes Affecting Minority AIDS Initiative and Part D Grantees, text, September 9, 2009; Washington D.C.. (digital.library.unt.edu/ark:/67531/metadc295014/m1/2/: accessed January 20, 2019), University of North Texas Libraries, Digital Library, digital.library.unt.edu; crediting UNT Libraries Government Documents Department.